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Laryngorhinootologie 2018; 97(01): 24-29
DOI: 10.1055/s-0043-110856
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Hypothyreose nach Hemithyreoidektomie − überraschend häufige Komplikation während der Nachsorge

Hypothyreosis after Hemithyroidectomy − surprisingly frequent complication in aftercare
Firat Elmas
1   Luzerner Kantonsspital, Klinik für Hals-Nasen-Ohren-Heilkunde
,
Fabienne Lauber
2   Universität Zürich, Medizinische Fakultät
,
Thomas Linder
1   Luzerner Kantonsspital, Klinik für Hals-Nasen-Ohren-Heilkunde
,
Werner Müller
1   Luzerner Kantonsspital, Klinik für Hals-Nasen-Ohren-Heilkunde
› Author Affiliations
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Publication History

Publication Date:
08 June 2017 (online)

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Zusammenfassung

Hintergrund Hemithyreoidektomie ist eine häufige Behandlung einseitiger Schilddrüsenknoten. Postoperative Hypothyreose ist eine häufig unterschätzte Komplikation. Wir untersuchten Inzidenz, Zeitpunkt, Symptomatik sowie mögliche Risikofaktoren der postoperativen Hypothyreose.

Material und Methoden 127 Patienten nach Hemithyreoidektomie wurden mit retrospektiver Datenanalyse sowie strukturierter Befragung der nachbetreuenden Hausärzte und Endokrinologen untersucht. Patienten wurden mit dem postoperativen TSH als hypothyreot (> 4.0 mU/L) oder euthyreot (0.4–4.0 mU/L) klassifiziert. Schilddrüsenhormone wurden nach 4–6 Wochen, 6 Monaten und 1 Jahr gemessen.

Ergebnisse 55 Patienten (43 %) entwickelten eine postoperative Hypothyreose und 72 (57%) blieben euthyreot. Die Hypothyreose zeigte sich innerhalb der ersten 2 Monaten bei 39 Patienten (71 %), zwischen 2–6 Monaten bei 13 Patienten (24 %) sowie nach 6–12 Monaten bei 3 Patienten (5 %). 33 Patienten (60 %) waren zum Zeitpunkt der Diagnose asymptomatisch. Nur 16 Patienten (29 %) hatten Symptome. Der präoperative TSH Wert war signifikant höher in der Gruppe der hypothyreoten Patienten (1.64), verglichen mit der euthyreoten Gruppe (1.13, P = 0.0017). Die anderen Variablen wie Alter, Geschlecht und präoperativen Werte von T3, T4, Calcium und PTH zeigten keinen signifikanten Unterschied.

Schlussfolgerung Die postoperative Hypothyreose ist eine häufige Komplikation nach Hemithyreoidektomie, welche nicht verpasst werden sollte. Präoperativ erhöhter TSH Wert ist ein Risikofaktor für die postoperative Hypothyreose. Alle Patienten nach Hemithyreoidektomie sollten postoperative TSH Kontrollen nach 4–6 Wochen, 6 Monaten und 12 Monaten haben.

Abstract

Background Hemithyroidectomy is a frequent treatment for thyroid nodules. Postoperative hypothyroidism is an often underestimated complication. We studied the incidence, time, symptoms and risk factors of postoperative hypothyroidism.

Material and methods 127 Patients were analyzed in a retrospective chart review and with a structured assessment of the general practitioners and endocrinologists. Patients were classified according to the postoperative TSH as hypothyroid (>4.0 mU/L) or euthyroid (0.4–4.0 mU/L). Thyroid hormone was assessed at 4–6 Weeks, 6 months and 1 year.

Results 55 patients (43 %) had postoperative hypothyroidism and 72 (57%) stayed euthyroid during follow up. The hypothyroidism occured during the first 2 months in 39 patients (71 %), between 2–6 months in 13 patients (24 %) and between 6–12 months in 3 patients (5 %). 33 patients (60 %) with hypothyroidism were asymptomatic and 16 patients (29 %) had symptoms. Preoperative TSH level was significantly higher in the hypothyroid group (1.64) compared to the euthyroid group (1.13, P = 0.0017). The other variables as age, gender, preoperative levels of T3, T4, Calcium and PTH showed no significant difference.

Conclusion Postoperative hypothyroidism is an important complication after hemithyroidectomy which should not be missed. Preoperative elevated TSH level is a riskfactor for postoperative hypothyroidism. All Patients after hemithyroidectomy should have postoperative TSH assessment after 4–6 weeks, 6 months and 12 months

Schlüsselwörter

Hemithyreoidektomie - Hypothyreose - TSH - Schilddrüsenknoten - Thyreoidektomie - Schilddrüse

Key words

hemithyroidectomy - hypothyroidism - TSH - thyroid nodule - thyroidectomy - thyroid
 

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